Objective To observe the influence of large dose of mecobalamin combining with breviscapin injection on the levels of serum tumor necrosis factor-α(TNF-α)and C-reactive protein (CRP)and the antithrombin Ⅲ(AT-Ⅲ)activity in the patients with diabetic foot(DF).Methods 240 cases of DF were divided into 4 groups according to the random number table method,60 cases in each group:the large dose of mecobalamin plus breviscapin injection group (group Ⅳ);the routine dose of mecobalamin plus brevis-capin injection group (group Ⅲ);the simple breviscapin injection group (group Ⅱ)and the routine dose of mecobalamin group (groupⅠ).4 weeks were taken as a course of treatment.The TNF-α,CRP levels and the AT-Ⅲ activity before and after the treat-ment were detected and performed the comparative analysis.Results The levels of TNF-α,CRP and AT-Ⅲ before treatment had no statistically significant differences among in the four groups (P >0.05).Compared with the results before treatment,the levels of TNF-αand CRP after treatment in 4 groups were obviously decreased and the AT-Ⅲ level was significantly increased,the differ-ences had statistical significance (P <0.05);compared with the group Ⅰ,Ⅱ and Ⅲ,the difference in the group Ⅳ had statistical significance(P <0.05).Conclusion Mecobalamin combined with breviscapin injection is able to decrease the serum inflammatory factors such as TNF-αand CRP,and increase the AT-Ⅲ activity in the patients with DF,which is more significant when increasing the mecobalamin concentration.Therefore,adopting the therapeutical scheme of increasing the mecobalamin concentration combined with breviscapin injection could obviously decrease the inflammatory reaction of DF with good safety,which is one of effective meas-ures for increasing the curative effect of DF.

Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.

Objective To sum up our clinical experience in interventional treatment of 143 cases of Budd-Chiari syndrome. Methods This study included 92 males and 51 females, aged from 6 to 65 years old with an average of 34.8 years. The pathologic types were composed of complete occlusion of inferior vena cava (IVC) (71), IVC stenosis (36), IVC membrane occlusion with a hole (29), membrane occlusion of hepatic vein (HV) (3), IVC thrombosis (4), and IVC lesions forementioned combined with HV occlusion (14). Therapeutic methods included that I: Percutaneous transinferior vena cava membranotomy and occlusion dilatation (PTA) (77); II: IVC PTA with stent (62); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4); V: Additional operation after intervention (16). Results The range of reduced IVC pressure was (3 ～ 29) cmH 2O with the mean pressure being 12.1 cmH 2O. Complications occurred in 8 cases, including pulmonary embolism (PE), stent migration and HV occlusion after IVC stent (2 cases respectively), cardiac tamponade and hemothorax (1 case repectively). 2 cases died of PE and 3 cases died of hepatic coma after meso-caval shunt,the death rate being 3 5% . A follow-up study showed the recurrence rates were 10.4% in IVC PTA cases and 1.6% in IVC PTA with stent cases respectively, and no recurrence was found in other cases. Conclusions ① PTA is the first choice for localized lesions without fresh thrombus. ② For those with elastic recoil or recurrence, stent is suggested. ③ For those with both IVC lesions and HV occlusion, the additional operation to reduce portal hypertension is needed after IVC intervention.

Objective To investigate the benefit finding for caregivers of patients with cancer and its influencing factors. Methods Totally 330 couples of cancer patients and caregivers were investigated from October 2014 to September 2015 by convenience sampling method. The cancer patients were investigated with the Hospital Anxiety and Depression Scale. The caregivers of cancer patients were investigated with Benefit Finding Scale, Zarit Caregiver Burden Interview, Medical Outcomes Study Social Support Survey. Results The total score of benefit finding was (59.65 ± 11.12) points. Regression analysis indicated that caregivers' education, religious, informational and emotional support, caregiver burden, patients' depression symptom, cancer stage and self-caring were influencing factors of benefit finding for caregivers (t=-3.689-5.913, P<0.01 or 0.05), which explained 30.0% of the variance. Conclusions The caregivers of patients with cancer have a low level of benefit finding. Oriented by influencing factors of benefit finding, the health workers should enhance targeted interventions, promote positive perception in the process of caring, develop the quality of caring and life.

Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate and primary health care utilization in Feixi county increased. Conclusion:Both the“bottom-up” exploration approach and “from point to area” implementation strategy adopted by Feixi county have not only been the core content of primary health care system’s comprehensive reform, but also effectively leveraged the other aspects of the reform. They have played an important role in deepening medical reform and establishing institutional mechanism of health care system.

Objective:The paper aims to explore the structure and effectiveness of three health service systems in Anhui province and provide policy recommendations to promote the integration of health care systems. Methods:By using typical sampling method, this paper conducts case study analysis of health service system in Ma’anshan, Feidong and Feixi county of Anhui province. The data mainly come from questionnaires for the institutions, doctors and patients, as well as from interviews with key informants. By integrating quantitative and qualitative data analysis, this paper uses social network analysis method to analyze the system structure and its degree of integration. Results:The degree of integration of health service structure in Ma’anshan is the highest, followed by Feixi, and Feidong is the lowest. The system effectiveness is same as the degree of integration. All three health service systems have advantages and disadvantages regarding to system integration. Conclusion:The effectiveness of health service system integration and its implementation is the product of combined effects of internal and external environment of each health service system. The reforms in Ma’anshan and Feixi health service systems have not only integrated health care structures, but also had a positive impact on the effectiveness of the health service systems.

Objective:To analyze reverse effects induced in the implementation process of“primary health care strengthening” policies, and the innovative initiatives and countermeasures raised in primary health care system’s comprehensive reform of Feixi county. Method:Based on the principles of Critical Discourse Analysis ( CDA) , this paper designs its analytical framework for policy analysis. Results:Many reverse effects appeared in the implementa-tion process of “primary health care strengthening” policies. However, through improvements in terms of manpower upgrading, network building, working conditions and management mechanisms, Feixi county has successfully strengthened the capacity building for primary health care institutions. Conclusions:The expected and unexpected re-sults should be evaluated systematically when the policies are being implemented, and local governments need to pro-ceed according to local conditions in order to prevent unintended reverse effects from happening.

The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

By means of field survey and expert consultation, the paper made a summary of the experiences learnt from medical aid in Wenchuan Earthquake, along with problems found. The summary and assessment covered the disaster-caused casualty and health among local residents, cost estimates for post-disaster medical aid, and targeted measures to improve medical aid plans. In addition, the authors proposed to emphasize the uniqueness of earthquake disasters and develop pre-plans in this regard, as well as such mid-and long-term plans for the promotion of disaster medicine, development of disaster medicine talents, upgrading of emergency medical rescue skills of medical staff, and volunteers management systems.